Novel Methods for Damage Control of Hyperkalemia in Combat Casualties
Technical Report,17 Nov 2016,08 Apr 2020
David Grant USAF Medical Center Travis AFB United States
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Objective Current techniques for renal replacement therapy RRT require 1 specialized equipment, 2 extensively trained personnel and 3 large logistical footprints. These constraints limit the Air Forces ability to provide life-saving treatments in forward deployed locations. Our innovations may allow for these treatments with negligible increases in equipment and logistical footprint. Furthermore, these techniques can be accomplished with minimal training for deployed providers. Methods For this program, three techniques for simplified RRT that require minimal training and supplies were tested. In the first aim Phase 2, Field expedient renal replacement therapy, we used a Belmont rapid infuser and improvised fluids to develop an improvised method for renal replacement therapy. In the second aim Phase 1, Potassium binding hemoperfusion, we developed a novel hemoperfusion filter to remove potassium, leveraging the Belmont as a blood pump. Lastly, in our third aim Phase 3, Novel peritoneal techniques, using a potassium binder with peritoneal dialysis fluid, the fluid can be recycled to remove potassium Results Phase 1 Serum potassium concentration was significantly lower in the treatment than in the control group over time P 0.02. Phase 2 No difference was found in electrolyte concentrations between the commercial and improvised replacement solutions. Phase 3 There was no statistically significant difference in serum potassium between groups over time p 0.766. Conclusions In austere settings, a simplified hemoperfusion system could be used to temporize patients with hyperkalemia until evacuation to a facility with traditional RRT. The ImpRRT system achieved similar performance to CRRT and may represent a potential option for temporary RRT following disasters. Lastly, the experimental device in Phase 3 used significantly less fluid and was able to control serum potassium levels with similar efficacy to that of peritoneal dialysis.
- Medicine and Medical Research